My son is 38 yrs old. He is about 410 lbs. He had a chest x-ray done the end of last week. He has previously had two stress tests and they were negative. His newest chest x-ray showed an enlarged cardiac silhouette, but his lungs were not fully expanded. His internist still hasn't looked at the x-ray. I am getting very upset about this. I am in the medical field and got the results the next day. He has a history of heart problems in his family. Can you shed some light on the subject to me and what can I do? Should he see a cardiologist? Thank you.

Hello Noreen. Given your son's weight and family history of heart problems, and given the results of the chest x-ray, a relatively straightforward solution may be obtaining a cardiac ultrasound (echocardiogram). Keep in mind that with his size the images may be a bit unclear; often injection of a non-x ray contrast agent may aid in improving the image quality.

A couple of points to note: Chest X-ray results may be affected by your son's size and the fact that the image was not taken during full inspiration. Conversely, his size does put him at risk for premature coronary disease. Another thing to keep in mind is that if he snores and/or has obstructive sleep apnea, very often the right ventricle and atrium may become dilated because of the pressure overload created by increased pulmonary pressures (pressures in the circulation feeding the lungs). Obviously weight loss is the single most important thing your son can do and there are many available strategies towards achieving this end. You and your son need to carefully review each of these issues with his physician. Good luck.